To determine epidemiological characteristics and clinical presentation of complete hydadititform mole (CHM) and complications associated with prophylactic chemotherapy with oral methotrexate. Setting: Prospective study. Methods: Ninety-four patients with clinically and histologically confirmed complete hydatidiform mole admitted between 1/9/1995 and 30/1/1998 were followed for periods ranging from 12 months to 30 months. Seventy eight (83.0) received a total of 187 courses of oral methotrexate (0.4 mg/Kg daily in 3 divided doses) as prophylactic chemotherapy. The main outcome measures were pre- - and post evacuation serum hCG levels and complications associated with oral methotrexate use. Results: The prevalence of CHM was 3.42 per 1;000 deliveries. The mean age of subjects was 29.6 +- 8.5 years. Eighteen women (19.1) were nulliparous and mean gravity was 8.3. Many women presented with high-risk disease. Risk factors for persistent trophoblastic disease were prior molar pregnancy; age 19 or 35 years and features of high-risk molar pregnancy. Twenty-four of the seventy - eight patients (30.7) developed complications; mainly mucositis and haematological toxicity (leucopenia; anaemia and thrombocytopenia); commonly after three or more course. Conclusion: CHM was common and many patients presented with high-risk disease. Oral methotrexate for prophylactic chemotherapy was tolerable and safe for the first 2 courses; but serious complications occur as the duration of treatment increases. Prophylaxis did not prevent development of (or death from) metastatic trophoblastic disease. Recommendations: Patients with CHM should be monitored for the development of post-evacuation trophoblastic disease. Those on prophylactic chemotherapy require close monitoring for the toxic effects of the drugs.

To determine epidemiological characteristics and clinical presentation of complete hydadititform mole (CHM) and complications associated with prophylactic chemotherapy with oral methotrexate. Setting: Prospective study. Methods: Ninety-four patients with clinically and histologically confirmed complete hydatidiform mole admitted between 1/9/1995 and 30/1/1998 were followed for periods ranging from 12 months to 30 months. Seventy eight (83.0) received a total of 187 courses of oral methotrexate (0.4 mg/Kg daily in 3 divided doses) as prophylactic chemotherapy. The main outcome measures were pre- - and post evacuation serum hCG levels and complications associated with oral methotrexate use. Results: The prevalence of CHM was 3.42 per 1;000 deliveries. The mean age of subjects was 29.6 +- 8.5 years. Eighteen women (19.1) were nulliparous and mean gravity was 8.3. Many women presented with high-risk disease. Risk factors for persistent trophoblastic disease were prior molar pregnancy; age 19 or 35 years and features of high-risk molar pregnancy. Twenty-four of the seventy - eight patients (30.7) developed complications; mainly mucositis and haematological toxicity (leucopenia; anaemia and thrombocytopenia); commonly after three or more course. Conclusion: CHM was common and many patients presented with high-risk disease. Oral methotrexate for prophylactic chemotherapy was tolerable and safe for the first 2 courses; but serious complications occur as the duration of treatment increases. Prophylaxis did not prevent development of (or death from) metastatic trophoblastic disease. Recommendations: Patients with CHM should be monitored for the development of post-evacuation trophoblastic disease. Those on prophylactic chemotherapy require close monitoring for the toxic effects of the drugs.

A Survey of the prevalence of refractive errors among children in lower primary schools in Kampala district. / Kawuma; MediMayeku; Robert

Refractive errors are a known cause of visual impairment and may cause blindness worldwide. In children; refractive errors may prevent those afflicted from progressing with their studies. In Uganda; like in many developing countries; there is no established vision-screening programme for children on commencement of school; such that those with early onset of such errors will have many years of poor vision. Over all; there is limited information on refractive errors among children in Africa. Objective: To determine the prevalence of refractive errors among school children attending lower primary in Kampala district; the frequency ofthe various types of refractive errors; and their relationship to sexuality and ethnicity. Design: A cross-sectional descriptive study. Setting: Kampala District; Uganda. Patients: A total of 623 children aged between 6 and 9 years had a visual acuity testing done at school using the same protocol; of these 301 (48.3) were boys and 322 (51.7) girls. Results: Seventy-three children had a significant refractive error of +-0.50 or worse in one or both eyes; giving a prevalence of 11.6and the commonest single refractive error was astigmatism which accounted for 52of all errors. This was followed by hypermetropia; and myopia was the least common. Conclusion: Significant refractive errors occur among primary school children aged 6 to 9 years at a prevalence of approaximately 12. Therefore; there is need to have regular and simple vision testing in primary school children at least at the commencement of school so as to defect those who may suffer from these disabilities.

Refractive errors are a known cause of visual impairment and may cause blindness worldwide. In children; refractive errors may prevent those afflicted from progressing with their studies. In Uganda; like in many developing countries; there is no established vision-screening programme for children on commencement of school; such that those with early onset of such errors will have many years of poor vision. Over all; there is limited information on refractive errors among children in Africa. Objective: To determine the prevalence of refractive errors among school children attending lower primary in Kampala district; the frequency ofthe various types of refractive errors; and their relationship to sexuality and ethnicity. Design: A cross-sectional descriptive study. Setting: Kampala District; Uganda. Patients: A total of 623 children aged between 6 and 9 years had a visual acuity testing done at school using the same protocol; of these 301 (48.3) were boys and 322 (51.7) girls. Results: Seventy-three children had a significant refractive error of +-0.50 or worse in one or both eyes; giving a prevalence of 11.6and the commonest single refractive error was astigmatism which accounted for 52of all errors. This was followed by hypermetropia; and myopia was the least common. Conclusion: Significant refractive errors occur among primary school children aged 6 to 9 years at a prevalence of approaximately 12. Therefore; there is need to have regular and simple vision testing in primary school children at least at the commencement of school so as to defect those who may suffer from these disabilities.

The adjuvanticity and immunogenicity of the heat-labile enterotoxin (LT) of Escherichia coli and of its non-toxic mutant; LTK63; was evaluated after intranasal administration of CBA mice with recombinant measles virus nucleoprotein (rMVNP) with or without LT or LTK63. Both LT and LTK63 were shown to be highly immunogenic with higher responses observed 4 weeks after the booster immunization. Although the nucleoprotein was immunogenic on its own; mice immunized with the nucleoprotein plus wild type LT produced significantly high antibody responses (p0.03). Mice that received the rMVNP with LTJ63 also generated strong antibody responses to rMVNP. These antibodies were also significantly higher than those of rMVNP alone (p>0.05). Data on IgG antibody isotype profiles showed that IgG 1 and IgG 2a were predominant in mice immunized with rMVNP + LT or LTK63 whereas IgG 1 predominated when rMVNP was given on its own implying that LT and LTK63 induce both Th1 and Th2-type immune responses. These results highlight the great potential of this non-toxic mutant of LT as a safe vaccine adjuvant.

The adjuvanticity and immunogenicity of the heat-labile enterotoxin (LT) of Escherichia coli and of its non-toxic mutant; LTK63; was evaluated after intranasal administration of CBA mice with recombinant measles virus nucleoprotein (rMVNP) with or without LT or LTK63. Both LT and LTK63 were shown to be highly immunogenic with higher responses observed 4 weeks after the booster immunization. Although the nucleoprotein was immunogenic on its own; mice immunized with the nucleoprotein plus wild type LT produced significantly high antibody responses (p0.03). Mice that received the rMVNP with LTJ63 also generated strong antibody responses to rMVNP. These antibodies were also significantly higher than those of rMVNP alone (p>0.05). Data on IgG antibody isotype profiles showed that IgG 1 and IgG 2a were predominant in mice immunized with rMVNP + LT or LTK63 whereas IgG 1 predominated when rMVNP was given on its own implying that LT and LTK63 induce both Th1 and Th2-type immune responses. These results highlight the great potential of this non-toxic mutant of LT as a safe vaccine adjuvant.

Spinal histoplasmosis is a rare disease condition that must be differentiated from other common inflammatory lesions of the spine such as tuberculosis. A case is presented of a pathologically proven African spinal histoplasmosis in a 39-year old female. Paraplegia and fever were the patient clinical findings. Cervical plain radiography demonstrated a lytic destructive process of the lower cervical spine with radiographic signs similar to tuberculosis. the surgical management and chemotherapy of histoplasmosis are briefly discussed.

Spinal histoplasmosis is a rare disease condition that must be differentiated from other common inflammatory lesions of the spine such as tuberculosis. A case is presented of a pathologically proven African spinal histoplasmosis in a 39-year old female. Paraplegia and fever were the patient clinical findings. Cervical plain radiography demonstrated a lytic destructive process of the lower cervical spine with radiographic signs similar to tuberculosis. the surgical management and chemotherapy of histoplasmosis are briefly discussed.